Management of tobacco smoking during breastfeeding

Tobacco smoking during lactation reduces milk production, interferes with the let-down reflex and changes the taste of breastmilk. Nicotine in breastmilk and environmental tobacco smoke on parents’ clothes, skin and furniture can cause colic, diarrhoea, tachycardia, irritability, apnoeic episodes and impairment of the immune system in the infant. These risks increase with the number of cigarettes smoked per day. Delaying smoking until after each episode of breastfeeding is completed minimises the amount of nicotine in the breastmilk.

Exposure to environmental tobacco smoke, both passive smoking and on objects and people in the environment, is a risk factor for sudden infant death syndrome.

If a breastfeeding patient continues smoking after a trial of behavioural interventions, combination NRT or bupropion use during breastfeeding is safer for their infant than further exposure to tobacco smoking.

No data support the safety of varenicline during breastfeeding.